What is the problem...can one define it? Let your voice be heard...

[yesmaster]

Imagine if 50 pgy-2 rad onc residents, if on July 1 they were pulled aside and told they’d be doing IM and med onc fellowships instead. It would be good for rad onc, med onc, and those 50 residents.

The med onc job market is “great, actually, it’s incredible.” It’s actually believable when a 1st year fellow on a J-1 visa says this.

Someone should make a survey asking if rad onc residents and attendings would be willing to do a 2 year fellowship to prescribe and manage systemic therapy for solid tumors.

If acgme and the other acronym time lords were okay with it, I’d bet some med onc programs would happily take a highly motivated golden era rad onc who did an IM internship. It could even be partly enfolded into residency in lieu of 12 months (up to 18-21 months) of research.

So many academic rad onc research careers built on combined modality therapy, odd that no one gives combined modality in practice.

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[Manatee3]

I personally would rather be a subspecialty of radiology/ IR. I did a prelim IM year at a major medical center/ university- no thanks.
The whole "DEI" thing really makes me angry- I managed to score 95%+ on my physics section of the boards- and I'm not a white male. Don't insult women/ URM- condescending to assume "math is too hard" ...

 

[goodkerma]

I personally would rather be a subspecialty of radiology/ IR. I did a prelim IM year at a major medical center/ university- no thanks.
The whole "DEI" thing really makes me angry- I managed to score 95%+ on my physics section of the boards- and I'm not a white male. Don't insult women/ URM- condescending to assume "math is too hard" ...

Being part of radiology does nothing to make us "oncologists" - it's going backwards. Meanwhile there is a high need for systemic therapy - no reason we shouldn't broaden our field to include concurrent ct and IO. Will be more convenient for patients as well - esp those who go to different clinics for chemo vs. RT.

 

[DrAdonis]

Being part of radiology does nothing to make us "oncologists" - it's going backwards. Meanwhile there is a high need for systemic therapy - no reason we shouldn't broaden our field to include concurrent ct and IO. Will be more convenient for patients as well - esp those who go to different clinics for chemo vs. RT.

100%. It should also be optional. It’s okay to do RadOnc alone.

 

[RadRadRad]

Being part of radiology does nothing to make us "oncologists" - it's going backwards. Meanwhile there is a high need for systemic therapy - no reason we shouldn't broaden our field to include concurrent ct and IO. Will be more convenient for patients as well - esp those who go to different clinics for chemo vs. RT.

The advantages of going back to being under radiology include
1. Historical precedent
2. Don’t have Medonc fighting against you. I doubt they want to train someone to subsequently take a portion of their business
3. Extend the training. 5 years radiology plus 2 year fellowship in radonc means nobody entering job market for 2 years
4. Radiology has been much smarter about residency expansion over last 20 years ( they are near the bottom of list In terms of percentage increase in positions)
5. Take the power away from radonc chairs who have demonstrated (as a generalization) no interest in serving as caretakers for the field

 

[RickyScott]

The advantages of going back to being under radiology include
1. Historical precedent
2. Don’t have Medonc fighting against you. I doubt they want to train someone to subsequently take a portion of their business
3. Extend the training. 5 years radiology plus 2 year fellowship in radonc means nobody entering job market for 2 years
4. Radiology has been much smarter about residency expansion over last 20 years ( they are near the bottom of list In terms of percentage increase in positions)
5. Take the power away from radonc chairs who have demonstrated (as a generalization) no interest in serving as caretakers for the field

You make some very good points, but for me personally, it would be a much easier transition to oncology than radiology, although I don’t know how representative that is. In the end, I don’t see us having much of a choice just as the specialty focused on treating syphilis folded into ID per Zeitman.

 

[temujim]

The advantages of going back to being under radiology include
1. Historical precedent
2. Don’t have Medonc fighting against you. I doubt they want to train someone to subsequently take a portion of their business
3. Extend the training. 5 years radiology plus 2 year fellowship in radonc means nobody entering job market for 2 years
4. Radiology has been much smarter about residency expansion over last 20 years ( they are near the bottom of list In terms of percentage increase in positions)
5. Take the power away from radonc chairs who have demonstrated (as a generalization) no interest in serving as caretakers for the field

re #2 -- that's the good thing about academic med onc -- they don't give s--t as long as someone is doing their notes.

 

[medgator]

100%. It should also be optional. It’s okay to do RadOnc alone.

Bingo. Some of us are set in very busy practices, at this point, I'm thrilled to refer out stuff like AI/lupron therapy to med oncs and fiducials to urology when possible in addition to the concurrent chemo business i refer out.

Last thing i want to do is start prescribing tmz, cis or carbo/taxol

 

[Palex80]

In the past few years I have seen a redefining of "what a radiation oncologist does" in some European countries.
I trained in delivering systemic therapy together with radiation therapy, but in the past years numerous clinics have given up their inpatient service and outsourced systemic treatment. This part remains part of the education curriculum for residents in some countries, but the trend is certainly downward.

Another interesting thing I have been observing is that medical oncologists increasingly become aware of when one can/should give RT and when not. I often get consults now "telling me what to do" more or less: "Please ablate this lesion", while earlier it used to be "Can you help you?".
I feel that the field is transforming more and more into a servives discipline, comparable to radiology (perhaps interventional radiology would be the best comparison?).

At the same time two major factors are transforming the way we work: AI and all the other non-physicians taking care of patients.
In a very pessimistic scenario, AI will do a lot of the stuff we do nowadays. Contouringis already happening. The "bastion" of plan evaluation is next. At the same time, non-physicians are taking multiple tasks we used to cover. I trained to provide palliative care, pain care, psychosocial support. All that is now covered by non-physicians, I just make phone calls.

The evolution of our field a complicated matter, some things are within our grasp to transform, other not.

 

[elementaryschooleconomics]

In the past few years I have seen a redefining of "what a radiation oncologist does" in some European countries.
I trained in delivering systemic therapy together with radiation therapy, but in the past years numerous clinics have given up their inpatient service and outsourced systemic treatment. This part remains part of the education curriculum for residents in some countries, but the trend is certainly downward.

Another interesting thing I have been observing is that medical oncologists increasingly become aware of when one can/should give RT and when not. I often get consults now "telling me what to do" more or less: "Please ablate this lesion", while earlier it used to be "Can you help you?".
I feel that the field is transforming more and more into a servives discipline, comparable to radiology (perhaps interventional radiology would be the best comparison?).

At the same time two major factors are transforming the way we work: AI and all the other non-physicians taking care of patients.
In a very pessimistic scenario, AI will do a lot of the stuff we do nowadays. Contouringis already happening. The "bastion" of plan evaluation is next. At the same time, non-physicians are taking multiple tasks we used to cover. I trained to provide palliative care, pain care, psychosocial support. All that is now covered by non-physicians, I just make phone calls.

The evolution of our field a complicated matter, some things are within our grasp to transform, other not.

Ah, so Rammstein was correct:

We're all living in Amerika,
Amerika ist wunderbar.

 

[RO28]

I did an IM year bring it

Same. 3 months in the ICU and more nights than a categorical must have been good for something.

 

[Clean7795]

The advantages of going back to being under radiology include
1. Historical precedent
2. Don’t have Medonc fighting against you. I doubt they want to train someone to subsequently take a portion of their business
3. Extend the training. 5 years radiology plus 2 year fellowship in radonc means nobody entering job market for 2 years
4. Radiology has been much smarter about residency expansion over last 20 years ( they are near the bottom of list In terms of percentage increase in positions)
5. Take the power away from radonc chairs who have demonstrated (as a generalization) no interest in serving as caretakers for the field

I don't think radoncs are generally interested in diagnostic imaging, which kills this idea. It would be like neurology going back under IM, or ENT going back under general surgery. The fields have diverged sufficiently in content and temperament that it will not go back.

On a theoretical level it would be kind of interesting. You could have a single rad-radonc running the tumor board imaging and being a one-stop-shop department for biopsy, interventional, and radiation procedures.

 

[yesmaster]

In the multiverse, there's other worlds in which rad onc leadership is expanding the scope of the field, pushing us to do biopsies, prescribe systemic therapies, and provide holistic care for cancer patients.

I know those worlds exist. Because I dream of them, every night.

Every night, the same dream. Every morning, the same clinical trials for omitting radiotherapy.

 

[thesauce]

Another interesting thing I have been observing is that medical oncologists increasingly become aware of when one can/should give RT and when not. I often get consults now "telling me what to do" more or less: "Please ablate this lesion", while earlier it used to be "Can you help you?"

Except that THEY DON’T send the appropriate patients for radiation. It’s like they know just enough to be dangerous. I have seen some of the most egregious radiation omissions from medonc. Sometimes the patient sniffs out that they are being misled and find their way to me and I’m like…WTF?

 

[medgator]

Except that THEY DON’T send the appropriate patients for radiation. It’s like they know just enough to be dangerous. I have seen some of the most egregious radiation omissions from medonc. Sometimes the patient sniffs out that they are being misled and find their way to me and I’m like…WTF?

Definitely one old school med onc i work with likes to send Palliative cases that are literally 1-2 steps away from a hospice consult

 

[Sheldor]

In the multiverse, there's other worlds in which rad onc leadership is expanding the scope of the field, pushing us to do biopsies, prescribe systemic therapies, and provide holistic care for cancer patients.

I know those worlds exist. Because I dream of them, every night.

Every night, the same dream. Every morning, the same clinical trials for omitting radiotherapy.

I know its a riff on a movie, but this is beautiful, haha

 

[thesauce]

Definitely one old school med onc i work with likes to send Palliative cases that are literally 1-2 steps away from a hospice consult

I know MANY that will use any excuse not to send for radiation. New drug that has a 1% chance to work on brain mets?? Don’t need RT anymore!

I know others that will actually talk in tumor board about radiation and argue with me as if they had ever planned a case. When you point out the huge flaws in their logic they say “I know that.” 🤦‍♂️

 

[RickyScott]

I know MANY that will use any excuse not to send for radiation. New drug that has a 1% chance to work on brain mets?? Don’t need RT anymore!

I know others that will actually talk in tumor board about radiation and argue with me as if they had ever planned a case. When you point out the huge flaws in their logic they say “I know that.” 🤦‍♂️

my experience as well

 

[CurbYourExpectations]

Oh no, not the dreaded REDDIT

The Narwhal Bacons at Midnight?